Dejerine’s Triad

Dejerine’s Triad is a three-part test for determining nerve compression which can arise from osseous foraminal
encroachment, disc protrusion (bulging), prolapse (herniation) or severe sprain/strain of the spine. It accomplishes
this by increasing the pressure of the cerebral spinal fluid.

The first part is the Valsalva maneuver. This is accomplished by having the individual sit erect, head up with forearms flexed to 90° with fist clenched. After this position is assumed, the individual is requested to take a deep breath and hold it while bearing down as if having a bowel movement. The individual should note if they experience sharp pain at the spine and report to the practitioner, at what segmental level it was experienced.

Click on a small image to view an enlarged image

The second part of this test is accomplished by having the individual replicate a cough while sitting erect. Again they should report if they notice any sharp pain and at the spinal level it occurs.

The third part of this test is achieved by inducing the individual to sneeze. However, because the violent action of sneezing could worsen a compromised annulus, we recommend that this third and final part of Dejerine’s triad not be performed. We suggest the practitioner inquire if sneezing seems to elicit the same type and location of pain as was experienced by the Valsalva and manufactured cough. Additionally, pain experienced at a specific segmental level from one or more of these maneuvers would be a positive concomitant for more specialized testing in the extended exam or by diagnostic imagery.